Extracting information on pneumonia in infants using natural language processing of radiology reports

Natural language processing (NLP) is critical for improvement of the healthcare process because it can encode clinical data in patient documents. Many clinical applications such as decision support require coded data to function appropriately. However, in order to be applicable for healthcare, performance must be adequate. A valuable automated application is the detection of infectious diseases, such as surveillance of pneumonia in newborns (e.g., neonates) because the disease produces significant rates of morbidity and mortality, and manual surveillance is challenging. Studies have demonstrated that automated surveillance using NLP is a useful adjunct to manual surveillance and an effective tool for infection control practitioners. This paper presents a study evaluating the feasibility of an NLP-based monitoring system to screen for healthcare-associated pneumonia in neonates. We estimated sensitivity, specificity, and positive predictive value by comparing results with clinicians' judgments. Sensitivity was 71% and specificity was 99%. Our results demonstrated that the automated method was feasible.     

Genetic differences influencing behavioral temperature regulation in small mammals. I. Nesting byMus musculus

Nesting behavior was found to differ for animals of five different inbred strains ofMus musculus reared in the same environment, indicating heritable differences in level of nesting byMus. For two separate crosses, hybrid animals built larger nests than did animals of the inbred parental strains. In addition, from data of one of the crosses and derived generations, a very low heritability of nesting but substantial dominance variance were found. This pattern of results is expected of characters which have been the target of natural selection. MaleMus were found to build larger nests than females of all groups tested. These findings suggest that nesting byMus musculus represents required thermoregulatory behavior.This research was supported by NSF grant GU 2591 and HEW grant NS 09536.     

A vocabulary development and visualization tool based on natural language processing and the mining of textual patient reports

Medical terminologies are critical for automated healthcare systems. Some terminologies, such as the UMLS and SNOMED are comprehensive, whereas others specialize in limited domains (i.e., BIRADS) or are developed for specific applications. An important feature of a terminology is comprehensive coverage of relevant clinical terms and ease of use by users, which include computerized applications. We have developed a method for facilitating vocabulary development and maintenance that is based on utilization of natural language processing to mine large collections of clinical reports in order to obtain information on terminology as expressed by physicians. Once the reports are processed and the terms structured and collected into an XML representational schema, it is possible to determine information about terms, such as frequency of occurrence, compositionality, relations to other terms (such as modifiers), and correspondence to a controlled vocabulary. This paper describes the method and discusses how it can be used as a tool to help vocabulary builders navigate through the terms physicians use, visualize their relations to other terms via a flexible viewer, and determine their correspondence to a controlled vocabulary.     

Evaluating a mental health assessment for older people with depressive symptoms in general practice: a randomised controlled trial.

BACKGROUND: There is a lack of evidence on the most effective primary care management of older people with minor depression. AIM: To evaluate a follow-up assessment by the community mental health team (CMHT) for older people with depressive symptoms identified by practice nurses at a health check for people over the age of 75 years. DESIGN OF STUDY: A pragmatic randomised controlled trial. SETTING: A single large general practice in Leicestershire. METHOD: Patients receiving a health check administered by a practice nurse and scoring 5 or more on the 15-item Geriatric Depression Scale (GDS15) were randomised to either follow-up by the CMHT or routine general practitioner (GP) care. The GDS15 score was measured at the subsequent health check 18 months later. RESULTS: Forty-seven patients were randomised to CMHT assessment and 46 to routine GP care. Uptake of the intervention was 72% (n = 34). At the follow-up health check a greater proportion of the control group had improved GDS15 scores (P = 0.08). Following assessment, the CMHT recommended their further involvement in the care of 12 patients and this was authorised by patients' GPs in six cases. CONCLUSIONS: A follow-up mental health assessment by a member of the local CMHT was not effective in improving outcomes for mildly depressed older people. Other than random error possible reasons for this include the length of follow-up and a failure to meet raised expectations among the intervention group. If complex referral procedures do not improve outcomes for this group, then specialist community services should play a more prominent part in the training of practice staff to care for their depressed older patients.     

Sterilitätsbehandlung mit donogener Insemination

Donor inseminations (DI) have been performed for decades. Most of the publications on this topic deal only with problems of tolerance and acceptance of this treatment for sterility. We already reported on them in parts I and II. In the present third and last part, we discuss the indications for DI: male infertility, genetic disorders, and unsuccessful assisted reproduction therapy. Which conditions do affect the success of therapy? Which methods are recommended? Our treatment results verify realistically that in effect DI only produces the desired child in about 50 % of the couples. As a complementary therapy, in vitro fertilization (IVF) with donor spermatozoa offers a real chance for pregnancy even for women whose husbands are infertile and who themselves suffer from impaired fertility such as pathological conditions of the fallopian tube or when simple inseminations have not resulted in pregnancy. After receiving consent from the State Physicians’ Chamber, we treated 19 women by donor IVF in our group practice and fulfilled their desire to bear their own child.     

Zonal distribution of glomerular collapse in renal allografts: possible role of vascular changes

Collapsing glomerulopathy (CG), an aggressive variant of focal segmental glomerular sclerosis, is a renal disease with severe proteinuria and rapidly progressive renal failure. The pathogenesis of CG is unknown. It strongly resembles human immunodeficiency virus (HIV)-associated nephropathy, but the patients are HIV negative. The characteristic glomerular lesion is capillary loop collapse with prominent podocytes filling Bowman's space. Interestingly, these glomerular changes are usually associated with severe tubulointerstitial injury, including tubular epithelial degenerative changes, microcystic dilation of several tubules, and interstitial inflammatory cell infiltrate. Recently, it became evident that the morphologic pattern of CG may appear not only in native kidneys, but also de novo in renal allografts, and that the pattern of CG in renal transplants is not always associated with severe proteinuria. Studies describing CG in renal allografts are all based on biopsies. We report 3 allograft nephrectomy specimens that showed a zonal distribution of the characteristic collapsing glomerular changes with associated tubulointerstitial injury. All 3 kidneys had obliterative vascular changes. One nephrectomy specimen had chronic obliterative transplant arteriopathy, 1 had acute vascular rejection, and 1 had thrombotic microangiopathy. None of the patients had severe proteinuria. Our cases suggest that the morphologic pattern of CG in renal allografts may not represent the same disease process as CG in native kidneys and provide further evidence that collapsing glomerular changes do not define the disease entity of CG, but rather represent a pattern of renal injury. Among other factors, hemodynamic disturbance may play a role in the development of the pattern of CG in renal allografts.     

Surveillance of Staphylococcus aureus in veterinary teaching hospitals

Staphylococcus aureus isolates (n = 70) from 65 patients (36 canine, 18 equine, 7 bovine, 2 avian, and 2 feline) at seven veterinary teaching hospitals in the United States were studied. The majority of patients (83%) with an S. aureus infection were canine and equine, but this may have reflected a sample bias based on clinic case loads and diagnostic lab submissions at the participating institutions. Fourteen percent of patients with an S. aureus infection were infected with a methicillin-resistant S. aureus (MRSA) isolate. Six of seven institutions had at least one MRSA infection during the study. Pulsed-field gel electrophoresis on 63 of the 70 isolates yielded 58 unique strains of S. aureus. None of the strain types of the MRSA isolates matched each other or the type of any other S. aureus isolate. The proportions of patients infected with an MRSA isolate were not significantly different between institutions or animal species (P > or = 0.222). Methicillin-resistant S. aureus isolates in this study seemed to be community acquired rather than hospital acquired.     

Filarial Nematode Parasites Secrete a Homologue of the Human Cytokine Macrophage Migration Inhibitory Factor

Filarial nematode parasites establish long-term chronic infections in the context of an antiparasite immunity that is strongly biased toward a Th2 response. The mechanisms that lead to this Th2 bias toward filarial antigens are not clear, but one possibility is that the parasites produce molecules that have the capacity to proactively modify their immunological environment. Here we report that filarial parasites of humans secrete a homologue of the human proinflammatory cytokine macrophage migration inhibitory factor (MIF) that has the capability of modifying the activity of human monocytes/macrophages. A cDNA clone isolated from a Brugia malayi infective-stage larva expression library encoded a 12.5-kDa protein product (Bm-MIF) with 42% identity to human and murine MIF. MIF homologues were also found to be expressed in the related filarial species Wuchereria bancrofti and Onchocerca volvulus. Bm-mif was transcribed by adult and larval parasites, and the protein product was found in somatic extracts and in the parasite’s excretory-secretory products. Immunohistocytochemistry revealed that Bm-MIF was localized to cells of the hypodermis/lateral chord, the uterine wall, and larvae developing in utero. Unexpectedly, the activities of recombinant Bm-MIF and human MIF on human monocytes/macrophages were found to be similar. When placed with monocytes/macrophages in a cell migration assay, Bm-MIF inhibited random migration. When placed away from cells, Bm-MIF induced an increase in monocyte/macrophage migration that was specifically inhibited by neutralizing anti-Bm-MIF antibodies. Bm-MIF is the first demonstration that helminth parasites produce cytokine homologues that have the potential to modify host immune responses to promote parasite survival.     

Diarrhea Associated with Vibrio fluvialis in the United States

We report the isolation in the United States of Vibrio fluvialis from the stools of a patient who had severe watery diarrhea without fever and who subsequently died. V. fluvialis, a known enteric pathogen in other parts of the world, should be suspected in patients with watery diarrhea, especially in coastal areas.